Exit this survey DCHS YSC Student Survey Fall 2011 1. DCHS Student Needs Assesment - Fall 2011 Please take 5 minutes to respond to this survey. This an anonymous survey, you will not be asked your name or email address at anytime. By responding to this survey the YSC will be better able to plan and provide the appropriate services for DCHS students. Thank you! Question Title * 1. What grade are you in? 9th 10th 11th 12th Question Title * 2. Do you know what the Youth Service is? Yes No Question Title * 3. Have you utlized any services provided by the Youth Service Center? Yes No Question Title * 4. When you are absent from school what is the most common reason? You are sick. A family member is ill. You just don't want to come. You have to work. You are too tired to come to school. There are no consequences when I miss school. So why come? Other (please specify) Question Title * 5. When you miss school due to illness, do you visit a doctor? Yes No If no, why? Question Title * 6. How often do you excercise weekly? Less than 1 time per week 1-3 times per week 4 or more times per week Question Title * 7. Would you consider your nutritional habits healthy? Yes No Question Title * 8. How many adults do you have in your life that encourage you to be your best? Less than 5 adults 5-10 adults 10-15 adults 15 or more adults Question Title * 9. How many adults do you think care about you? Less than 5 adults 5-10 adults 10-15 adults 15 or more adults Question Title * 10. What percentage of your friends are sexually active? Less than 20% of my friends 20-50% of my friends 50-80% of my friends over 80% of my friends Question Title * 11. Are you sexually active? Or have you been in the past? Yes No Question Title * 12. Do you have a job outside of school? Yes No Question Title * 13. Are you looking for a job? Yes No Question Title * 14. Do you plan on graduating from high school? Yes No Question Title * 15. What keeps you from dropping out of school? Self Motivation Peer Support Parent Support Teacher Support Other (please specify) Question Title * 16. What do you plan on doing after graduation? Attend College or University Attend Technical College Work Armed Forces Not Sure Question Title * 17. Have you visited the school nurse or have you in the past? Yes No Question Title * 18. Please check all programs that you feel would be beneficial for DCHS students: Summer Programs Healthy Relationships - Dating College/Post High School information Fitness, excercise & nutrition STD/HIV education Teen Parenting ACT Prep programs Other (please specify) Question Title * 19. Please check any needs that you or your family may have: Basic needs (clothes, food, hygiene) Eye Exams/Glasses Emergency Dental Care School supplies Holiday Assistance Extra Curricular Program Other (please specify) Question Title * 20. Comments, Concerns, Questions: Done